hiatus hernia Flashcards
define hiatus hernia?
prolapse of the upper stomach through the diaphragmatic oesophageal hiatus
causes of hiatus hernia
- Congenital
- Traumatic
- Non-traumatic
what are the two types of hiatus hernia and what are their features?
o Sliding – 95% of all hernias. The gastroesophageal junction moves above the diaphragm. o Paraoesophageal (rolling) – the gastroesophageal junctions remains below the diaphragm but another part of the stomach herniates through the oesophageal hiatus
what are the risk factors of hiatus hernia?
o Obesity o Low-fibre diet o Chronic oesophagitis o Ascites o Pregnancy
epidemiology of hiatus hernia?
- Common in WESTERN countries
- Increased frequency with age
- 70% of patients are > 70 yrs
what are the presenting symptoms of hiatus hernia?
• Most are ASYMPTOMATIC
• Sliding hernias are more likely to cause symptoms
• Patients may present with symptoms of GORD
o Heartburn
o Waterbrash
what are the signs of hiatus hernia?
• Usually NO SIGNS
identify investigations for hiatus hernia?
• Bloods
o FBC - check for iron deficiency anaemia
• Radiology
o CXR - gastric air bubble may be seen above the diaphragm
o Barium swallow
• Endoscopy
what is the medical management plan for hiatus hernia?
o Modify lifestyle factors (e.g. lose weight)
o Inhibit acid production (e.g. PPIs)
o Enhance upper GI motility
what is the surgical management plan for hiatus hernia?
o Necessary in a MINORITY of patients
o Nissen Fundoplication
what are the oesophageal complications?
o Intermittent bleeding o Oesophagitis o Erosions o Barrett's oesophagus o Oesophageal strictures
what are the non-oesophageal complications>
o Incarceration of hiatus hernia
o This can lead to strangulation and perforation
what is prognosis for patients with hiatus hernia?
- Generally GOOD
* Sliding hernias have a better prognosis than rolling hernias
